International Journal of Retina and Vitreous最新文献

Background: To evaluate postoperative outcomes, including redetachment rates, in eyes with rhegmatogenous retinal detachment (RRD) following early or late removal of silicone oil (ROSO).

Methods: This retrospective single-center study included 58 pseudophakic eyes that underwent 23-gauge pars plana vitrectomy (PPV) with silicone oil endotamponade (SOE). Patients were divided into two groups: Group I (ROSO ≤ 12 weeks) and Group II (ROSO > 12 weeks) with SOE duration of 2.3 +/- 0.7 months and 5.2 +/- 1.9 months, respectively. Clinical outcomes, including redetachment rates, best corrected visual acuity (BCVA), cystoid macular edema (CME), epiretinal membrane (ERM) formation, and intraocular pressure (IOP) changes, were analyzed. Kaplan-Meier estimation and Log-Rank tests were used to assess redetachment.

Results: Redetachment occurred in a total of 13 eyes (22% of patients) (Group I: 7 (21%), Group II: 6 (23%); p = 1.00). The cumulative incidence of redetachment was comparable between groups (Log-Rank test: p = 0.88). Final BCVA at the last follow-up showed no significant difference between Group I (0.8 ± 0.5 logMAR) and Group II (0.8 ± 0.7 logMAR; p = 0.36). Postoperative incidences of CME (Group I: 13 (41%), Group II: 9 (35%) p = 0.78), ERM (Group I: 13 (41%), Group II: 7 (27%) p = 0.40), and elevated IOP (Group I: 7 (22%), Group II: 7 (27%) p = 0.76) were also comparable between groups.

Conclusions: Early ROSO (≤ 3 months) does not appear to increase the risk of retinal redetachment or adversely affect visual and anatomical outcomes. These findings support the feasibility of earlier ROSO in selected cases, potentially reducing the risk of silicone oil-related complications.

Objective: To detect and quantify intermittent capillary perfusion using optical coherence tomography angiography (OCTA) in patients with branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), proliferative diabetic retinopathy (PDR), and healthy control eyes.

Methods: OCTA images were acquired from patients with BRVO(n = 9), CRVO(n = 8), PDR(n = 8) and healthy controls(n = 10). Five 6 × 6 mm scans were registered and averaged at baseline (T0) and thirty minutes after (T30) into single en-face images of the superficial and deep vascular complexes (SVC and DVC). Pixels were labeled as vessel or non-vessel using a previously published machine learning model. Loss of Perfusion (LoP) was defined as the percentage of vessel pixels present in T0 image that disappeared at T30, and Gain of Perfusion (GoP) was defined as the percentage of vessel pixels that appeared in T30 image. The amount of intermittent capillary perfusion was the sum of GoPLoP.

Results: Patients with PDR, CRVO and BRVO showed significantly higher GoPLoP values than controls in both the macular and temporal regions. The temporal region generally exhibited significantly greater GoPLoP values than the macular region. Layer analysis indicated a significantly higher GoPLoP within the DVC compared to the SVC. There was a significant negative correlation between perfusion density and perfusion variability.

Conclusion: Our results demonstrate higher GoPLoP in BRVO, CRVO, and PDR patients compared to controls. This measure may be utilized as a novel biomarker of tissue hypoxia. Further studies are necessary to better elucidate the role of GoPLoP in monitoring disease progression and treatment efficacy of retinal vascular diseases.

Aim: Chronic Persistent Diabetic Macular Edema can be a clinical challenge. The aim of this study is to assess the outcomes of intravitreal brolucizumab 6 mg/0.05 ml for persistent diabetic macular edema (P-DME) in a real-world clinical setting.

Methods: A prospective interventional trial of consecutive patients with P-DME was conducted at a tertiary care center in India. P-DME was defined as edema persisting despite more than three intravitreal anti-VEGF injections or despite a combination of anti-VEGFs, intravitreal steroids and/or laser photocoagulation. The change in visual acuity (VA), central retinal thickness (CRT) and any incidences of adverse effects were analyzed.

Results: 19 eyes of 13 patients received a mean of 3.3 injections at a mean interval of 11.1 weeks. The median VA improved from 0.40 logMAR (20/50) to 0.35 logMAR (20/44) after a mean period of 13 weeks after the last injection, which was statistically significant (p = 0.004). The CRT reduced from 517 microns to 237 microns (p = 0.001). One patient had an episode of intraocular inflammation, which was treated successfully with topical steroids. The same patient again received brolucizumab with no recurrent inflammation.

Conclusions: Intravitreal brolucizumab helped improve visual acuity in patients with P-DME and achieved a reduction of 54.1% in the CRT at a longer mean reinjection interval. The rate of intraocular inflammation was 5.2% without any permanent visual impairment.

Purpose: Age-related macular degeneration (AMD) is a leading cause of irreversible blindness in older adults, with its prevalence rising globally. This review aims to explore the potential of Efdamrofusp alfa (EA), a novel bispecific decoy receptor fusion protein targeting both VEGF and complement pathways, in treating neovascular AMD (nAMD).

Methods: A comprehensive literature search was conducted across PubMed, Cochrane and Embase till March 2025 to find articles evaluating the efficacy of EA in the treatment of neovascular AMD. Observations from early pre-clinical studies and clinical trials were analyzed to determine the efficacy and safety of EA.

Results: A total of five preclinical and clinical studies were included, encompassing 66 animal subjects and 880 human participants. Efdamrofusp alfa (IBI302) neutralizes both C3b/C4b and VEGF, demonstrating anti-angiogenic effects in preclinical models. Clinical trials examined intravitreal doses ranging from 0.05 mg to 4.00 mg. EA showed efficacy in reducing central retinal thickness and improving visual acuity, with a safety profile comparable to existing anti-VEGF treatments. Treatment-emergent adverse events (TEAEs) included conjunctival hemorrhage, ocular hypertension, and keratitis, which were similar to those observed with other intravitreal anti-VEGF drugs. The drug demonstrated noninferiority to aflibercept in improving best-corrected visual acuity (BCVA) and significantly reduced central subfield thickness.

Conclusions: Efdamrofusp alfa shows promise as a novel treatment for nAMD, potentially offering improved efficacy over current anti-VEGF therapies. Nonetheless, further large-scale randomized clinical trials are essential to confirm its efficacy and safety in broader populations. The dual-inhibition strategy provides a new avenue for personalized AMD treatment, particularly for patients unresponsive to monotherapies.

Background: To observe the changes of choroidal thickness (CT) and choroidal vascularity index (CVI) in patients with macular edema secondary to branch retinal vein occlusion (BRVO) after multiple intravitreal injections of ranibizumab.

Methods: A retrospective cohort study was conducted on 91 patients (91 eyes) with unilateral BRVO treated with a 3 + PRN (pro re nata) regimen of ranibizumab from January 2022 to March 2023. Optical coherence tomography (OCT) was used to measure central retinal thickness (CRT). Enhanced depth imaging OCT (EDI-OCT) was used to measure subfoveal CT (SFCT), nasal CT (1.5 mm from the fovea), and temporal CT (1.5 mm from the fovea) to calculate the mean CT. Choroidal images were binarized using ImageJ software to quantify the luminal area (LA), stromal area (SA), and total choroidal area (TCA), from which CVI (LA/TCA) was calculated. These parameters were evaluated at baseline and 1 month after each injection and were compared across different types of macular edema and between the acute and stable phases of BRVO.

Results: At baseline, the cystoid macular edema (CME) group had significantly lower CRT and SFCT compared to the diffuse retinal thickening (DRT) and mixed-type groups (P < 0.01); however, best-corrected visual acuity (BCVA) and CVI did not differ significantly among the groups. In BRVO-affected eyes, CT, LA, SA, TCA, and CVI were all significantly higher than in contralateral eyes (P < 0.01). Compared to baseline, CT decreased significantly after the first injection and stabilized after the second (P < 0.01). CVI decreased significantly after the second injection and remained stable thereafter (P < 0.01). These changes persisted for at least six months after the final injection.

Conclusions: BRVO affects both retinal and choroidal structures. BRVO-affected eyes exhibit choroidal vasodilation, stromal thickening, and have higher CT and CVI values compared to unaffected eyes. Anti-VEGF therapy effectively reduces CT and CVI during the acute phase, leading to a stable state. CVI values do not appear to differ based on the morphological type of macular edema.

Trial registration: ChiCTR2400090054. Registered on 13 November 2023, retrospectively registered.

Objective: This study aims to characterize the baseline profile and clinical outcomes of pneumatic retinopexy (PR) in patients fulfilling the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) eligibility criteria at a tertiary referral center in Colombia.

Methods: This retrospective consecutive case series included patients with primary rhegmatogenous retinal detachment (RRD) meeting PIVOT criteria between January 2021 and April 2024. The primary outcome was single-operation success (SOS) at 3 months, defined as complete retinal reattachment after one PR procedure, allowing for a supplementary gas injection within 21 days.

Results: 563 newly diagnosed primary RRD cases were reported, 143 (25.4%) were PIVOT-eligible and 105 underwent PR. The SOS rate was 85.7% (90/105). Baseline age, sex, lens status, and macular status were comparable between success and failure groups. Detachment extent > 2 quadrants correlated with an increased risk of failure (p = 0.045); however, this association should be interpreted cautiously given the limited number of events.

Conclusions: Approximately one-quarter of primary RRD cases at our center met PIVOT criteria. In this cohort, PR yielded a high SOS rate and remains a valuable first-line surgical option in appropriately selected patients, particularly in settings with constrained resources.

Corneal collagen cross-linking (CXL) is widely used to halt the progression of keratoconus by biomechanically strengthening the corneal stroma; however, its potential effects on retina and choroid remain unclear. This systematic review and meta-analysis synthesized current evidence on structural and microvascular changes in the posterior segment following CXL in patients with keratoconus, assessed by optical coherence tomography (OCT) and OCT angiography (OCTA). A comprehensive search of PubMed, EMBASE, and Web of Science was performed up to May 24, 2025. Random-effects meta-analysis using Hedges' g was applied to pool quantitative data. In addition, studies that met the eligibility criteria but lacked sufficient data for quantitative synthesis were qualitatively assessed and included in the descriptive analysis. Ten studies involving 233 eyes from 215 keratoconus patients were included. Meta-analysis demonstrated no significant change in central macular thickness at 1 month (Hedges's g = -0.15; 95% confidence interval [CI]: -0.44 to 0.13; p = 0.30) or 6 months (Hedges's g = -0.12; 95% CI: -0.47 to 0.22; p = 0.48). Subfoveal choroidal thickness also remained unchanged at 1 month (Hedges's g = -0.14; 95% CI: -0.45 to 0.17; p = 0.37). Sensitivity analyses confirmed the robustness of these results. In the qualitative synthesis, parameters demonstrated overall stability, aside from a few exceptions. In conclusion, current evidence suggests that CXL does not result in clinically meaningful changes in posterior segment structure or microvasculature in keratoconus patients. These findings support the posterior segment safety of CXL.

Purpose: To estimate the amount of eliminated vitreous after ultrasound-guided pars plana vitrectomy and complete the safety profile of the technique.

Methods: We enrolled patients with vitreous hemorrhage and clear media who had an ultrasound-guided pars plana vitrectomy. The amount of eliminated vitreous was calculated by digital analysis (ImageJ) of before and after photos, obtained intraoperatively. All cases were completed under direct visualization for safety evaluation. All patients had a comprehensive ophthalmological examination at baseline and at day 1, and 1 month follow-up. Adverse events were reported in proportions ± 95%CI. A learning curve was plotted via the formula y = ax^b. Interobserver agreement was assessed with a Cohen-Kappa test.

Results: We enrolled 62 patients. Mean age: 64.3 ± 13.3 years. Digital image analysis showed that there was a significant reduction in the number of pixels representing vitreous hemorrhage (≈ 70%, p < 0.01). The minimum number of cases needed to achieve a 70% or greater elimination of vitreous was 18. The proportion of potentially related adverse events to the surgical technique was 1.6%, 95%CI: 0.04-8.66).

Conclusion: Ultrasound-guided pars plana vitrectomy is feasible and has an acceptable safety profile for cases with minimal to no visibility of the posterior pole.